Life Insurance Lawyer New Mexico

Whether you reside in: Roswell; Santa Fe; Rio Rancho; Las Cruces or Albuquerque;
our life insurance attorneys who live and work here in New Mexico are
here to help resolve your delayed or denied life insurance claim.

Life insurance and the commission of crimes

Life insurance companies are like any other for-profit business. They exist
for the sole purpose of making the most money for executives and shareholders.
To do this, they need to collect as much money as possible. This typically
happens by collecting premiums from policyholders. In addition to that,
however, life insurance companies strive to avoid spending money. To achieve
this goal, they try very hard to avoid paying out claims against policies.

Indeed, life insurance companies (and the armies of lawyers they employ)
have become experts at concocting reasons for denying claims. This claim
denial process begins before a single person ever purchases a policy.
It begins with the drafting of long-winded, complex, and oft-times confusing
policy language. The most important provisions of these policies for the
insurance companies are the exclusions.

Exclusions are basically formal reasons why the life insurance company
can deny a claim. Some common exclusions include suicide, material misrepresentations
in the application process, and nonpayment of premiums. Of course, there
are lesser known exclusions as well. One of those involves death during
the commission of a crime.

This article explores a case where an insurance company used this lesser
known exclusion to deny a valid claim for death benefits. Fortunately,
this case turned out favorably for the beneficiary. Many, however, do
not – especially when beneficiaries try to navigate the muddy waters
of the insurance industry on their own.

A passionate romance

The case at hand involves a married couple – Linda and John. Linda
and John met while they were attending college and fell madly in love.
Within a year of graduation, they were married. Driven by a common desire
to succeed, both of them obtained graduate degrees and went on to accept
high-paying jobs in medical research and development.

Everyone who knew John and Linda knew one truth about them – as much
as they loved one another, they were prone to having epic arguments. This
was true from the outset of their relationship and was an unfortunate
reality that plagued them throughout their lives together. Ultimately,
it was their passionate arguing that led to John’s demise.

One fourth of July, John and Linda attended a large party at the home of
one of their friends. The home was located out in the country off of a
narrow and winding road. Though John had agreed to act as the couple’s
designated driver that evening, he ended up having a few drinks before
the sun went down. This angered Linda who, having had several drinks herself,
proceeded to berate John in front of their friends.

Enraged, John hopped in the couple’s car on his own. As he sped away
from the party, several people expressed concern for his safety. Knowing
the couple’s propensity to fight and make up rather quickly, however,
no one did anything to stop John.

Unfortunately, this was to be the couple’s last fight. As he sped
away from the party, John failed to negotiate a curve in the road and
his car veered off an embankment. John’s body was found in the car
the next morning. He had not survived the impact.

The police undertook a full investigation surrounding the circumstances
of the accident. The police report noted that John may have been driving
as fast as 100 miles per hour – a speed that constituted a felony
in that state. Not having any witnesses to the accident, however, their
only conclusive finding was that John was driving above the posted speed
limit when he lost control of the car. A coroner’s report stated
that John’s cause of death was blunt force trauma occasioned by
the accident.

Life insurance claim denied

Shortly after the accident, Linda dug out John’s life insurance policy.
The policy provided a death benefit of $50,000, plus an additional $150,000
if John died accidentally. Linda made a claim for the full $200,000 benefit.
Given that John died in an accident, Linda never thought her claim would
be denied.

That is exactly what happened, however. Nearly one month after Linda submitted
her claim, she received a claim denial letter in the mail. The stated
reason for the denial was that John died during the commission of a felony
(driving in excess of 100 mph) and that the policy contained an express
exclusion relieving the insurance company from paying a claim under such
circumstances.

Linda was devastated. On top of losing her husband, she was now unsure
how she was going to pay off the mortgage on the couple’s house.
Just as she was becoming resigned to the claim denial, a friend suggested
she call an attorney specializing in the wrongful denial of life insurance claims.

It’s a good thing she did. The attorney successfully argued in court
that there had been no conclusive finding that John was driving at a felony
rate of speed at the time of his death. Rather, police simply noted that
he “may have” been driving 100 mph. Without additional proof
that a felony occurred, the life insurance company had no basis for invoking
the felony exclusion of John’s life insurance policy.

Ultimately, the court agreed. It awarded Linda the full policy benefit,
with interest. That allowed Linda to pay off the mortgage and begin to
piece her life back together without the strain of financial insecurity.

As lawyers who specialize in the wrongful denial of life insurance claims,
we see insurance companies employ these tactics every day. They will twist
facts and reach unsupportable conclusions in a simple effort to avoid
paying out on otherwise valid claims. While this may be a way for them
to increase profits, it is a practice that can destroy the lives of beneficiaries.

If you or someone you love has had a life insurance claim denied for a
reason that just doesn’t seem fair, call us today. We’ll talk
over the circumstances of your case and let you know whether we believe
you can successfully contest that denial. We’re here to help.

New Mexico denied life insurance claims are nothing new. Existing for many
years, life insurance policies have been used to safeguard families and
friends alike in case emergencies or accidents come unexpectedly. Unfortunately,
denials of life insurance claims, as well as delays are commonplace.

Our life insurance lawyers who live and work in New Mexico can help, whether
you are in: Albuquerque; Las Cruces; Rio Rancho; Santa Fe; Roswell; or
anywhere in the state of New Mexico, we will get you the benefits to which
you are entitled.

New Mexico Life Insurance Law

Policies through work are governed under ERISA. The primary regulating
force here in New Mexico is Title 13 of the New Mexico Administrative
Code, and oversight is provided by the Office of Superintendent of Insurance.

Most Common Reasons for a Denied Life Insurance Claim in New Mexico

Number one is a misrepresentation on the application. This typically involves
failing to disclose a medical condition. However, we can get over this
hurdle the majority of the time.

A lapse of a life insurance policy is probably second most common. What
happens is that the insured gets sick and misses a payment or two. These
are tough, but often we can get these claims paid.

Probably third is the type of death exclusion. This could be a suicide
or it could be a self-inflicted injury. Murder is another exclusion. Health
again can fall under this exclusion. We often win suicide exclusions as
we cite case law that the death was actually accidental.

A very common exclusion is the alcohol exclusion. The insured may have
been killed in a car crash, but the autopsy revealed alcohol in the person’s
system. We have many legal briefs to combat this exclusion.

Heroin and opiates or illegal drug exclusion is one of the biggest now.
With the opioid crisis, there are tens of thousands of deaths.

Prescription drug overdose exclusion may involve an overdose of medicine
or taken medicines that are contraindicated.

An ex-spouse being cut off from life insurance benefits is a big one. We
actually have a half dozen ways to get over this hurdle.

Having a spouse not listed as a beneficiary is another reason for denial

Having a child not listed as a beneficiary is one too.

Having only a primary beneficiary who is deceased is another.

On an AD&D (accidental death and dismemberment) life insurance policy,
a fall not being considered an accident is extremely common.

The insured’s age not being correct on the initial application is
a reason for denial.

Having the wrong social security number listed is common.

An autoerotic asphyxiation exclusion is an easy one for us to beat.

An omission on the application is a big reason for denying a life insurance
claim, but we have legal briefs to this effect.

Not providing the required documents to the insurance company after death
is a reason.

Information which is argued to not be correct is one.

When there is a dispute between two or more beneficiaries, an interpleader
may occur, and we always get these resolved quickly.

A beneficiary not named is a reason for not paying it out.

A life insurance policy may be transferred from one company to another
by the employer which causes major problems.

Life insurer denies claim because policyholder failed to submit a form
it never requested

Court finds the insurer breached the duties it owed to the policyholder
by failing to flag the issue

Life insurance companies have all sorts of rules and regulations that policyholders
must abide by in order for the policy to remain effective. If you’ve
ever tried to read a life insurance policy from cover to cover, you know
that keeping track of all of these rules can be a dizzying task. Nonetheless,
insurers aren’t always eager to tell policyholders when they’ve
missed something. After all, a policyholder’s failure to abide by
the letter of the policy may be sufficient reason for the insurer to deny
an eventual claim for death benefits.

The ability to deny death payouts is an attractive prospect for an insurance
company. Each time an insurer finds a way to collect premiums from policyholders
while avoiding paying death benefits, the company’s profits soar
and shareholders get richer. That’s one of the reasons policies
are so complicated. If the policyholder misses something, it can render
their policy effectively useless.

Such was the case for a woman named Ann who lived in Michigan. Ann had
received a standard life insurance policy plus supplemental coverage through
her employer. She faithfully paid all of her premiums. Nonetheless, when
Ann passed away, her beneficiaries were denied the full death benefit
Ann intended for them. How could this be? The insurance company claimed
Ann had never submitted a certain form required by her policy. The only
problem was, neither the insurance company nor Ann’s employer had
ever provided her with that form.

Our law firm specializes in the wrongful denial of life insurance claims.
Thus, we’re not surprised at all by the circumstances of Ann’s
case. Nonetheless, we think it is important for our clients and potential
clients to understand the various excuses life insurers use to deny valid
claims. We also think it is important for them to see – as happened
in Ann’s case – that life insurance claim denials can be contested
and successfully overcome. The key, in our opinion, is for beneficiaries
to retain qualified attorneys who practice in this area day in and day out.

Now, let’s take a closer look at what happened with Ann’s situation.

An employer-sponsored policy

As noted above, Ann’s $100,000 life insurance policy was a benefit
of her employment. Although Ann was responsible for paying the monthly
premiums, her employer automatically withdrew the premiums from her paycheck
each week. The employer also offered Ann the opportunity to purchase supplemental
life insurance. In a nutshell, so long as Ann paid higher premiums, she
could raise her policy benefits substantially through that supplemental plan.

Ann chose to raise her policy benefits to $400,000. Her employer accepted
her choice and religiously extracted the additional premiums from her
paycheck each week. The insurance company sent her an email confirming
the supplemental coverage and congratulating her on her choice to obtain
the coverage. Ann named her parents as the beneficiaries under her policy.

Ann’s untimely death

A couple of years after obtaining the $400,000 total policy coverage, Ann
became gravely ill. She died a short time later. Already overcome with
grief, Ann’s parents had the unpleasant task of making a claim for
death benefits under Ann’s policy. Ann had talked to them about
the policy prior to passing away so they knew she had faithfully paid
the premiums. Ann also gave them all of the documents, emails, and other
communications relating to the policy.

In light of all this, Ann’s parents were shocked when the life insurer
promptly denied their claim for supplemental coverage. While the company
was willing to pay the $100,000 due under the standard policy, they claimed
Ann was ineligible for the supplemental coverage. The company’s
reasoning surprised Ann’s parents even further.

The company claimed that in order to be eligible for supplemental coverage,
Ann needed to have filled out an Evidence of Insurability Form (“EIF”).
Throughout the life of the policy, they claimed, Ann never filled out
an EIF. Thus, according to the insurer, Ann’s parents were not entitled
to the supplemental payout.

At this point, Ann’s parents did a wise thing. They hired an attorney
who specialized in the denial of life insurance claims. The attorney reviewed
the stack of documents Ann had given to her parents relative to her life
insurance. The attorney confirmed what Ann’s parents told him –
those papers were replete with emails and other documents congratulating
Ann on her decision to purchase supplemental coverage. There were also
receipts for the additional premiums Ann had paid to obtain such coverage.
Nowhere, however, was there any indication from the insurance company
or Ann’s employer that Ann needed to fill out an EIF in order to
have a valid policy.

The lawsuit

Notwithstanding this evidence, the insurance company continued to refuse
the supplemental payout. Consequently, Ann’s parents instructed
their attorney to sue the company. At trial, Ann’s parents prevailed.
The court found that either the insurance company or Ann’s employer
had a duty to notify her that her supplemental life insurance policy was
void without the EIF. The court also found that the failure to give such
notice was likely intentional. At the end of the day, Ann’s parents
were awarded the full amount of the supplemental coverage Ann believed
she had purchased.

This case illustrates just how important it is for beneficiaries to contact
an attorney any time they are faced with a life insurance claim denial.
If Ann’s parents had simply given up when they received the initial
denial letter, they would have lost out on $300,000 that their daughter
intended for them to receive upon her death.

As lawyers who specialize in this area of the law, we have seen these and
other tricks insurance companies play to deny valid claims. We’ve
spent years successfully contesting such claims and getting our clients
the death benefit payments they deserve.

If you’re facing denial of a life insurance claim, please call us
today. We’re here to help.

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